9512 HOLLY DR 2023-06-08 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SEKVIGES EVERETT 9200 CEDAR STREET, EVERETT, WA F&M (P)42526]d810 I(E) Peomlt8erwinattevm we govI xww evernernever govlpermlts PROJECT SITE INFORMATION PROJECTADDRESS: 9512 HOLLY DR, EVERETT, WA98204-2608 BUILDINGAREA: 1676 ni PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT +❑REMODEL BUILDING USE: FIBER ❑TOWNHOUSE []DUPLEX El ADD ❑MULTI -FAMILY -M OF UNITS:_ ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 2000 JASSOCIATED BUILDING PERMIT g(if applicable)62205-018 DESCRIBE SCOPE OF WORK: ALTERATION OF MULTIPLE CIRCUITS TO PROVIDE POWER FOR LIGHTING AND HEATING FOR ALTERED ROOMS. ALTERATION OF MULTIPLE CIRCUITS TO PROVIDE POWER FOR LIGHTING AND HEATING FOR ALTERED ROOMS. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO '❑YES-SelecsS :❑Service ❑Feeder "❑Circuithri ❑fmplele Rewire LOVVVOLTAGEWORK? ONO DYES-00Devii SELECT SCOPE( REWIRED):❑Data ❑ Intercum ❑Thermostat El Audio ❑Secure Access ❑Security System ❑ Fire Alarm - Installations under this permit only include eleencal wring mugb-in of the system. An additional Fire Alarm Permit Is required for review of device location and Installation approval. ❑ Other (List Alp: CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH ANDIOR PERSONAL CARE FACILITIES: kJ NO LJ YES — See Below 8 Pg.2 O By checking this box, I am slating that I have read and understand all of WAS 296-468-900, selected the specific reason on page 2 of this application (see next page), AND Plan Review is NOT required because I meet all of the fallowing sub sections Mat do not Sae Pege2 require Plan Review. AR[DYES tomE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO ES -See Boom 8 Pi ElPursuent to RCW 19.28.261, Propertyowners and leaseholders cannot Perform elMdcal work on buildings for rent, sale, or lease without the proper electrical licensing and cedi0cation, or exemption. By checking this box, I am staling that I have completed and See Page signed Me AFFIDAVIT on page 8 of this application to receive exemption from this licensinglcedifcation requirement. CONTACT INFORMATION OWNER NAME: KIHARA AMOS TENANT BUSINESS NAME fit Commercial: OWNER MAILING ADDRESS: sn 9512 HOLLY DR m EVERETT TATEWA z„98204-2608 c a OWNER PHONE: 206 661 2200 OWNER EMAIL: amoskw@yahoo.com CONTRACTORNAME: HOMEOWNER DOING THE WORK CONTRACTOR ADDRESS: Mai SAM ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR I *REOUIREDI: ICITY OF EVERETT BUSINESS LIC. REQUIRED): PRIMARY CONTACT: []OWNER CONTRACTOR❑OTHER (Please Specify) DESIGNER OF RECORD CO AS CONTACT NAME: CSL DESIGNS CONTACT EMAIL csltlesg s2l@gmail.wm AGREEMENT IMreby cr em,Matlhe"man Sud&rrmbretl free app'kalbn are krow Me sans to be lruf are comi AO peami of lam And aMranme poveMmO Mvs fyyeo/awk wSM mmpWtlxhMhwspb%MMan a-YKK TM pnnNgaleprrWMesMgesune bgiw w16wi1Y to volaKwunallhepmrsima Many Chirac Hah wbvNawryWatingcma4uNm wMaperlmmntt Mmna0ue0m. Tlrallwnaullwrwtlbyhire onmrolfnupopMybparlmnMre wM1brxlvelr apphaNmume0.anbl cwrrprY v^Mr hire SfM LorAaclm lax fa2]RLW wN2R8.2Ltl WAC Case of Evi Offciil use On PERMIT%: eb 8i31/2022 J E PvmerlAumonaM Agent Signature Dale lRavlaed MW]0xx) Page I~IcWon